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Health Assessment > Breasts, Axillae & Regional Lymphatics (Exam 2) > Flashcards

Breasts, Axillae & Regional Lymphatics (Exam 2) Flashcards

1
Q

2 Types of Glandular Tissue

A

• lobules
• lactiferous sinuses

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2
Q

Lobules

A

clusters of alveoli that produce milk that empties into a lactiferous duct

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3
Q

Lactiferous sinuses

A

reservoirs for holding milk

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4
Q

Suspensory (Cooper) Ligaments

A

fibrous tissue that support breast tissue, and attaches to chest wall

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5
Q

Adipose Breast Tissue

A

bulk of breast tissue composition, varying proportions based on things like age, cycle, pregnancy, lactation, and nutrition

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6
Q

What are the 4 quadrants of the breast?

A

Upper inner, upper outer, lower inner, and lower outer (plus tall of spence)

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7
Q

Where is the location of most breast tumors?

A

upper outer quadrant

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8
Q

4 Lymphatic Nodes of the Breast

A

central axillary nodes, pectoral, subscapular, and lateral

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9
Q

The nipples in females have….

A

tiny milk duct openings

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10
Q

Montgomery glands (areolas)

A

small rounded elevations formed by sebaceous glands that aid in lactation

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11
Q

Epidermal ridges (milk lines) present during…

A

embryonic life

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12
Q

Where does breast tissue develop?

A

develops along the ridge of the thorax, rest of the ridge atrophies

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13
Q

Supernumerary nipple (third nipple)

A

may persist along the track of the ridge; usually inverted, flat, and non functional

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14
Q

Puberty: _________ stimulate breast tissue changes

A

estrogen levels

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15
Q

How does estrogen stimulate breast tissue changes in puberty?

A

enlargement of fat deposits, growth of duct system, and potential development of alveoli

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16
Q

Aromatase

A

fat cells, that secrete a form of estrogen

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17
Q

Higher BMI is linked to….

A

earlier onset of breast tissue development

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18
Q

How has the mean onset of breast development been affected in the last century?

A

development has dropped, possible due to obesity epidemic

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19
Q

Breast tissue changes vary by….

A

race, ethnicity and BMI

AA: 8.8 years
Hispanic: 9.2 years
White: 9.6 years
Asian: 9.9

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20
Q

What is Tanner staging?

A

the five stages of breast tissue development

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21
Q

What are the 5 Tanner stages?

A

I- Prepubertal
II- Breast budding
III- Enlargement
IV- Secondary mound formed by areola
V- Single contour of breast and areola

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22
Q

Thelarche

A

beginning of breast development

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23
Q

Full development of stages 2-5 of breast tissue development average over…

A

3 years; pubic and axillary hair develops as well

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24
Q

Menarche

A

onset of menstruation; occurs in tanner stage 3-4 around 12 yrs old

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25
Q

Size of fully developed females may ebb and flow with….

A

hormonal changes during cycles

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26
Q

Pregnancy: breast changes occur during which month?

A

second month; early sign of pregnancy

27
Q

Why do breasts enlarge and feel more nodular during pregnancy?

A

expansion of ductal systems, supporting fatty tissue, development of true secondary alveoli

28
Q

What happens to areolae during pregnancy?

A

they become larger and darker as pregnancy progresses, color may fade after but size remains; increased vascularity as well

29
Q

When is colostrum expressed during pregnancy?

A

Fourth month

30
Q

What is colostrum?

A

precursors for milk, containing protein and lactose; produced again after the first few days of delivery that are rich in antibodies

31
Q

What decreases/atrophies during post-menopause?

A

ovarian secretion of estrogen and progesterone, breast glandular tissue (replaced with fibrous connective tissue), subcutaneous tissue, axillary hair

32
Q

Breast cancer specific mutations

A

BRCA 1 and BRCA 2

33
Q

A woman today is _____ as likely to die of breast cancer than 30 years ago

A

half

34
Q

Mammography ages

A

annual screening for at risk women 40-44 years of age, and definite for 45

35
Q

Mammography barriers

A

lower income, lower education levels, unemployment, pain, embarrassment, and lack of health insurance

36
Q

Modifiable Breast Cancer Risk Factors (7)

A

• nulliparity or first child after 30 years old
• current oral contraceptive use
• long term use of HRT
• not breast feeding
• excessive alcohol intake
• obesity (especially after menopause)
• physical inactivity

37
Q

Non-modifiable Breast Cancer Risk Factors (9)

A

• first degree relatives of BC patients who were diagnosed premenopausal and had bilateral disease HAVE GREATEST RISK
• female over 50 years old
• personal history
• BRCA 1 or BRCA 2 gene mutation
• history of hyperplasia on biopsy
• previous breast irradiation
• menarche before 12 yrs old
• menopause after 50 years old
• white people

38
Q

Breast: Collecting Subjective Data (9)

A

• pain
• lumps
• discharge (color, consistency, odor)
• rash
• swelling
• trauma
• history of breast disease
• surgery/radiation
• medications

39
Q

Breast PCC: Subjective Data (2)

A

• breast self examination
• last mammogram

40
Q

Axilla: Subjective Data (2)

A

• tenderness, lump or swelling (lymph nodes)
• rashes (allergic reaction?)

41
Q

Breast: Collecting Objective Data (4)

A

• note appearance of skin
• size and symmetry (slight asymmetry is normal)
• contour
• characteristics of nipple

42
Q

Positioning for retraction screening for breasts

A

arms at sides and over head, hands against hips, leaning forward

43
Q

Retraction could be a sign of….

A

fibrosis (dimpling or puckering)

44
Q

Inspecting/Palpating Axillae

A

• note rashes/ discoloration
• note enlarged and tender lymph nodes
• lymph nodes not usually palpable
• some tenderness is EXPECTED high in axilla

45
Q

How to palpate axillae? (4)

A

I- down the chest wall from the middle of the axilla
II- anterior border of axilla
III- posterior border of axilla
IV- inner aspect of inner arm

46
Q

What position is most beneficial for palpating lumps?

A

supine; pillow under shoulder

47
Q

How to palpate breast?

A

use pads of first 3 fingers to make gentle rotary motion, varying pressures; vertical strip pattern for detecting lumps (start high in axilla and palpate down midaxillary line)

48
Q

Palpating nipples

A

observe any masses or discharge

49
Q

What to note when lumps/masses are detected (10)

A

• location
• size
• shape
• consistency
• movable
• distinctness
• nipple
• skin over the felt lump
• tenderness
• lymphadenopathy

50
Q

BREAST acronym

A

B- Breast mass
R- Retraction
E- Edema
A- Axillary mass
S- Scaly nipple
T- Tender breast

51
Q

Best time of the month for breast self examinations (BSE)?

A

day 4-7 of cycle (after menstrual period)

52
Q

Benign (Fibrocystic) Breast Disease Characteristics (8)

A

• multiple tender masses
• swelling and discomfort
• nodularity
• mastalgia
• cysts
• infection and inflammation
• DOMINANT LUMPS
• NIPPLE DISCHARGE

53
Q

Benign Breast Disease Breast Lumps (9)

A

• round or lobular
• firm/soft/rubbery
• well demarcated
• usually more than one
• mobile
• NO skin retractions
• tender and possible changes with menses
• size changes
• decrease incidence after 50 years old with menopause

54
Q

Malignant Breast Lumps (8)

A

• 30-80 years old and increases after 50 yrs
• irregular or star shaped
• firm to stone hard
• poorly defined
• single
• usually non tender
• skin retraction- dimpling
• continues to grow

55
Q

Preventing Lymphedema in a Mastectomy Patient (3)

A

• no blood pressure or needle sticks in affected limb
• patient usually wears compression sleeve
• limb alert bracelet

56
Q

Assessing the Male Breast

A

can be abbreviated but NOT omitted; inspect chest wall, palpate nipple area and axillary lymph nodes

57
Q

Gynecomastia

A

benign growth of male breast tissue; unilateral or bilateral and usually benign

58
Q

Gynecomastia could be related to…

A

anabolic steroids, medications and liver disorders

59
Q

Male breast cancer

A

is rare; usually painless, firm, retro-areolar lump

60
Q

When does the engorged breast during lactation occur?

A

postpartum day 3 or 4

61
Q

4 common abnormal breast findings

A

• dimpling
• nipple retraction
• edema (peau d’orange)
• deviation in nipple pointing

62
Q

3 Nursing Diagnosis for Breasts

A

• disturbed body image
• ineffective coping
• grieving

63
Q

SUMMARY CHECKLIST: BREASTS AND REGIONAL LYMPHATICS EXAM (5)

A

I- inspect breasts as patient sits, raises arms overhead, pushes hands on hips, leans forward
II- inspect supraclavicular and infraclavicular areas
III- palpate axillae and regional lymph nodes
IV- with patient supine, palpate breast tissue including tail of spence, nipples and areolae
V- teach BSE (?)

Health Assessment (19 decks)

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